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Dual contraceptive method use in HIV-serodiscordant Kenyan couples
  1. Alison C Roxby1,
  2. Leïla Ben-Youssef2,3,
  3. Grace Marx4,
  4. Freda Kinoti5,
  5. Rose Bosire5,
  6. Brandon Guthrie1,6,
  7. Romel Mackelprang6,
  8. James Kiarie7,8,
  9. Grace John-Stewart1,6,9,10,
  10. Carey Farquhar1,6,10
  1. 1Assistant Professor, Departments of Medicine and Global Health, University of Washington, WA, USA
  2. 2Resident Physician, Department of Emergency Medicine, Alameda County Medical Center, Highland Hospital, Oakland, CA, USA, and University of Washington School of Medicine, WA, USA
  3. 3Infectious Disease Fellow, Department of Medicine, University of Colorado, Aurora, CO, USA
  4. 4Physician, Kenya Medical Research Institute, Nairobi, Kenya
  5. 5Senior Clinical Research Scientist, Kenya Medical Research Institute, Nairobi, Kenya
  6. 6Assistant Professor, Departments of Epidemiology and Global Health, University of Washington, Seattle WA, USA
  7. 7Acting Instructor, Department of Global Health, University of Washington, Seattle, WA, USA
  8. 8Professor, Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya and Department of Obstetrics and Gynaecology, Kenyatta National Hospital, Nairobi, Kenya
  9. 9Professor, Departments of Medicine, Global Health, Pediatrics, and Epidemiology, University of Washington, Seattle, WA, USA
  10. 10Professor, Departments of Medicine, Epidemiology, Global Health, University of Washington, Seattle, WA, USA
  1. Correspondence to Alison C Roxby, Assistant Professor, 325 Ninth Avenue, University of Washington, P.O. Box 359909, Seattle, WA 98104-2499 USA; aroxby{at}u.washington.edu

Abstract

Background World Health Organization (WHO) guidelines recommend dual contraceptive method use with condoms and another contraceptive to reduce both incidence of HIV/sexually transmitted infection transmission and unintended pregnancies. This qualitative study assessed the barriers to and motivations for dual contraceptive use in Kenyan HIV-serodiscordant couples.

Methods HIV-serodiscordant couples in Nairobi, Kenya, were recruited from two longitudinal cohorts. Qualitative semistructured interviews were conducted using a semistructured questionnaire. Twelve male and 12 female members of serodiscordant couples and 10 women with incident pregnancies during the cohort studies were included.

Results Few couples reported using dual contraceptive methods, with men reporting more condom use than women. No HIV-seropositive men or HIV-seronegative women reported using non-condom contraception. Men and women agreed that men play a dominant role in decisions to use both condoms and contraception in HIV-serodiscordant couples. Participants reported that perceptions of side effects, male partner preference, and reproductive desire were critical factors in contraceptive decisions. Both men and women saw dual contraceptive method use as redundant and a sign of possible unfaithfulness. Many participants actively desired pregnancy, but few were able to accurately define monthly fertility windows.

Conclusions Dual contraceptive method use was low in these HIV-serodiscordant couples, with some couples finding it unnecessary while using condoms, and others being more focused on conceiving a child. Biomedical HIV prevention, including male circumcision, pre-exposure prophylaxis or antiretroviral therapy to reduce HIV transmission, may be more acceptable strategies to promote safer sexual relations among HIV-serodiscordant couples and safer conception when desired.

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Footnotes

  • LBY and ACR contributed equally.

  • Funding This research was supported by the UW Center for AIDS Research (CFAR), funded by the National Institutes of Health (NIH) (P30 AI027757), K24 AI087339, K23HD071788, K01AI098527, R01HD23412, and the American Relief and Recovery Act. LBY, ACR, RB were supported by the Fogarty International Clinical Research Scholars and Fellows Program funded under NIH Fogarty International Center grant R24 TW000007; LBY, GM and RB were also supported by the International Clinical Research Fellows Program at Vanderbilt University, R24 TW007988; and LBY received support from the University of Washington Global Health Opportunities Fellowship. GM was supported by a PReP Junior Investigator award. The parent cohort studies were funded by US National Institutes of Health (NIH) R01 AI068431 and by the Bill and Melinda Gates Foundation (#47674).

  • Competing interests None declared.

  • Ethics approval Institutional Review Board at University of Washington and Ethical Review Committee at the University of Nairobi, Nairobi, Kenya.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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